Impact of a pharmacist on medication discontinuation in a hospital-based geriatric clinic.

The effect of a pharmacist on drug prescribing in a hospital-based geriatric clinic was studied. On July 1, 1987, a geriatric clinical pharmacist began participating in a geriatric ambulatory-care clinic at a Veterans Administration medical center. In this retrospective study, patients who had been seen at the clinic a minimum of every two months during both the control period (January 1 through June 30) and the study period (July 1 through December 31) were included. During the study period, the pharmacist reviewed each patient's medication profile and assessed whether drug dosages should be adjusted or medications should be discontinued. The pharmacist and the geriatrician who coordinated care at the clinic reviewed the cases before changes were made. The total number of prescription and nonprescription medications (excluding one-time orders for short-term therapy) was determined for each time period, as well as the average number of prescriptions per patient. Those drugs most frequently associated with adverse drug reactions (ADRs) in the elderly were analyzed separately. During the control period, the 72 patients in the study group received 414 prescriptions, 246 of which were for medications associated with ADRs in the elderly. During the study period, there was a 32% reduction in the total number of prescriptions; the number of medications associated with ADRs in the elderly was reduced by 42%. A direct cost savings of +3872, or +53.75 per patient, was realized over the six-month study period. The addition of a pharmacist to the staff of a hospital-based geriatric clinic resulted in a 32% reduction in the total number of medications prescribed.